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HomeMy WebLinkAboutSEQUOIA ESTATES BLK 1 LT 6equoia Block 1 Lot 6 #017-152-06 Jul 15 22 08:05p Anchorage Well & Pump Ser 9072430742 p.1 MUNICIPALITY OF ANCHORAGE Development Services DepartmentOME Phone: 907-343-7904 Fax:907-343-7997 On -Site Water &Wastewater Section Pump Installation Log Well Drilling Permit Number: Parcel Identification Number: 017_152_06 Date of Issue: Legal Description SEQUOIA ESTATES Block 1 Lot 6 Property Owner Name & Address: VANDEHEY DAVID E & MELANIE S 6600 GUNNISON DRIVE ANCHORAGE, AK 99516 Pump Installation Date: e6 - 7 - 2022 Pump Intake Depth Below Top of Well Casing: 230 feet MYERS Pump Manufacturer's Name: 3NFL72-8-P4-02 Pump Model: Pump Size: 175 by Pitless Adapter Burial Depth: 12 feet MARTINSON Pitless Adapter Manufacturer's Name: Pitless Adapter Installer: \, Well Disinfected Upon Completion? A Yes ❑ No Method of Disinfection: PELLETS / Comments: me:.ANCHORAGE WELL &PUMP SERVICE 7640 KING STREET r ANCHORAGE, AK 99518 907-243-0740 y: State: Zip: Attention: The pump installer shall provide a pump installation log to On-site within 30 days of pump installation. V' MUNICIPALITY OF ANCHORAGE ®. DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME q PHONE �iC7 A � ! J .3 ❑UPGRADE MAILING ADDRESS B U <`'�'p -7 v ' C c� �r� LEGAL DESCRIPTION (/BCA ���` � �• 6.rr'�(�i /'�. / �-PC.��� .� r��>��� LOCATION q f NO. OF BEDROOMS Well ! ` Absorption ar a y Dwelling f PERMIT NO. S2 Y DISTANCE TO: 1 0 .� V° NF Manufacturer Materiel ` ( No. of compartm Liq. capacity in gallons O IF HOMEMADE: Inside length Width Liquid depth �� �� Cj Y DISTANCE TO: Well � Dwellin ' PERMIT NO. J z Z N Manufacturer Material Nearest lot line Liquid capacity in gallons PERMIT NO. O •-�= DISTANCE TO: Well - w u- z z¢ No. of lines Length of each line tn. f lines Trench width Distance between lines + inches f.- Top of the to finish grade ath til, Total effective absorption area �ut inches Length c Width f De(;h /r f PERMIT NO..F .h ( F l.'UUe%"' 1K rk rc _ice - Type of cr Crib diame erA Crib dept ,j_ Total ffective absorption area uj 0� Nlv� 7� Q Uj 0 DISTANCE TO: Well f P5� Building foundati n 9 Nearest lot line f �O J Class Depth Driller Distance to lot line PERMIT N0. J w DISTANCE TO: Building foundation e in Se Septic tank Absorption area(s) OTHER PIPE MATERIALS SOI L TEST RAT NGL/ �7 411 INSTALLER REMARKS I� •f ge Ici _. 61il a llr� : 3r - -, e t - l f. Nam.P APPROVED DATE LEGAL c-�,, ,nev. 01 iol .L �~ | �� Wei 1.1 KII X 111 1: M OT; L.. 1: - I Ch �11�����C3 C!ll C-3 K. E � DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L GTREET, ANCHORAGE, AK 99501 264--4720 413 INJ--- Ems X A- FEE S3 top FE the top ��� �BEE ���� PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: , 850448 ENGINEERED DESIGN 07/26/85 �TEV�N F/ WILSON 8040 ROAD, ANCH`RAGE, AK 99507 344~9134 SUBDIVISION: SEQUOIA ESTATES �ECTION: 26 TOWNSHIP: 121\1 39000 (SQ. FIT'. OR ACRES) V \ LOT' : 6 BLOCK: 1 RANGE: 3W I certify that: 1. I a0 familiar, with the requiPements for on-site sewers and wells as sc�t f'oPth by the of* Ancliorage (MOA) af-id the State oH, Alaska. 2" I will ingtall the system in accordanc�-� with all MOA codes and re�ulationsv and in co0pliance with tie design criteria of' this 1.-jeP0it^ 3" I Will adhere to all MOA and State of Alaska f*or the set back distaOcus From amy exigting well, wastewater, diGpc-)sal siy5tem or, �Vblic sewerage system on this or any adjacent or nearby lot" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDIIqG CODES, THEN (1) AN ELECTRICAL PERNIT AND INSPECTION MUST BE OBTAINED; (2) AS^BUILTS WILL NOT BE AP D WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE I,K 1- E C: -1, Rl I w T BE DONE BY A LICENSED ELECTRICIAN" SIGNED / DATE: ~~~. ~.��~�����.��- -~ APPLICANT: STEVEN F/ WILSON ' ISSUED BY DATE: ~-\ J��u��i^���[`� . O�� (ENGINEEF%,SEAL) Municipality of Anchorage � DEPARTMENT OF HEALTH &HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: C�'�EU�! (i✓ i f5cn•i '' ^^ -DATEPERFORMED: LEGAL DESCRIPTION: 7 ( 5C ez,i 'Township, Range, Section: p 7 - SLOPE SITE PLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS -�:4f/JA Ir r�7` %cc.i�-�2(4 a/ ' L WAS GROUND WATER ENCOUNTERED? 00 S IF YES, AT WHAT L DEPTH? 0 P E Depth to Water After Monitoring? Date: ©s Reading Date Gross Time Net Time Depth to Water Net Drop �2-iG� �.«_— U a��C2 �40 11K 0 17 3 O (9U �T_ / MZ 0 - 7 &�3 /0 0-';-( x( 10 PERCOLATION RATE— (minutes/inch) PERC HOLE DIAMETER G `EST,♦�ipL,BETWEEN�,,?0 FTAND� � �FT 11 t r" PERFORMED BY: C 7`(% {% I ^�_ CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) unicip iiity of POi_ 6-650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 Anchorage f, J "� I TONY KNOWLES. MAYOR DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Permit #:840885 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 6 Block 1 Sequoia Estates Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. if a private engineer inspected the installation of the on-site sewer system, the original as -built inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call this office at 264-4720. Sincerely, Keith E. Banda Sup or P Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 m R.p wo x co ::c. Fr�- irs. :Fr: -ii . . .... ir" �� 1!- -11 "E-A! lli:�:: C-.-li� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264~4720 / 1:1 UP, �1[,--, 4 �: C� PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESC�IP: LOT SIZE: LOT LOCATION: 840885 ENGINEERED DESIGK| 10/17/84 STEVEN F WILSON . P O BOX 3-818 ECB ANCHORA8E, AK 99501 561~5040 SUBDIVISION: SEQUOIA ESTATES LOT: 6 BLOCK: 1 SECTION: 26 TOWNSHIP: 12N RANGE: 3W 39137 (SQ.FT" OR ACRES) CORNER GUNNISION AND SEQUOIA I certify that: 1. I am �amiliar with the requirements "or on-site sewers and wells as set forth by the Anchorage (MOA> and the State o� Alaska, 2^ I will install the system ih accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3" I will adhere to aIl MOA and State o{ Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewer�ge system on this or any or nearby lot" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES; THEN (1)ER AN ELECTRICAL PMIT I AND INA SPECTION MUST BE OBTAINED; (2) ASBULS IT WILL NOT' BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL ST BE DONE BY A LICENSED ELECTRICIAN. SIGNED /al _�_ r ' APPLICANT: STEVEN F WILSON ISSUED BY DATE: '« ^~~~_�~___.~.~.�~�~.��_.���_~.~ �-�'.�.~^o~_ v ALASKA ENVIRONMENTAL CONTROL SERVIC' 'NC. 1200 West 33rd Avenue Suite B ANCHORAGE; ALASKA 99503 Phone 561.5040 JOB SHEET NO. . —1 OF CALCULATED BY &eo o, DATE CHECKED BY DATE_ SCALE M i 5 PAOOUCtXXI = Irc, wm mm 01471. ALASKA ENVIRONMENTAL CONTROL. SkRVICF NC. 1200 West 33rd Avenue Suite B ANCHORAGE,..ALASKA 99503 Phone 5615040 JOB `J4eye ky/Yso'l SHEET NO. q/ "-2 OF CALCULATED BY LIPN UI/ 5 DATE CHECKED BY -_DATE_ SCALE &T S � SLOf E A" 0�5,? 'c"La •`�� p pe �9 soft, a(�av se,ye ick a" Polys% wcnr. INs,1a o� per .3 J ks'�a,l( l-�� a�avve -}u rs(� graclf it _1 FWaIWMI W. V. 01471. ALASKA Ei14VIRUNIv1LN i AL ...... - _-- —.-------_.—__-- CONTROL SERVI( INC. SHEET NO 2 of _ 1200 West 33rd Averwa Suite B SF CORDS 8/30/84 ANCHORAGE, ALASKA 99503 REV/SED BY DATE Phone 561.5040 CHECKED BY DATE_ L /FT STAT/ON DETAIL GALVANIZED OR PAINTED /%4 D/A PULL -PIPE CONNECTED TO METAL COVER NEMA 4 2 URE THANE FOAM P/TL ESS ADAPTER FOR ENCLOSURE GLUED TO COVER PUMP REMOVAL GROUND L EVEL POWER AND PUMPi CONTROL LINES I- (� / DIA STEEL PIPE" \ .P/TL ESS ADAPTER / CONDUIT 2 FILLET WELD AROUND PIPE 4"DIA SOLID PVC PIPE , FROM SEPTIC TANK CALDER COUPLING DIFFERENTIAL MERCURY FLOAT SWITCH INSIDE OF PI SHALL BE COATED W/TH S/TUM/NOUS PAINT OR 7•A FKM ?w Baas w c'm mm oil?] PUMP CONTROL PUMP POWER ALARM CORD z / 4'L211 COUPL ING MIN 2"SOL ID PE ORA TO ABSORPTION / AREA JIM HEA r TAPE GAL VAN/ZED STEEL .(ASTM A-4444-76) OR ALUMINUM CULVERT — - -- --f- ALARM LEVEL 6��- — — �� — -- — BUMP ON L EVEL AMP l \ 24 1 — — — — — — PUMP "OFF L EVEL PUMP e o 0 6 B GALVANIZED OR —..� PAINTED STEEL PLA 36 r - I\ phone 276.1301 CHECKED er • &GALE t�i f.IELD C/0 DETAIL q, 'BELOW GZ0UPQD 1.,EVEL. �' 13E�pW G Rou'�D uF Uf (- y"303H PJ - DATE _ I \\ 303H INC. PE,az FLEX ABS „T° 4o END CpD XI�EDuIE 40PPrioo'o c� pvc IA 6�d HEAT TRACE, U95 C CNEeS LETS l(w*T souvc; APFAC Fr FROM bTFT 15TATZON NOTES : _ _ �ISURf L14F g2i W OFT-STATJON :IS &AR7.f D T LEAST _ Jl FUT BELOW ¢ROuNo LEVEL . QKe ._PW :DA FLEX ASS 5C4;E0QLE-atO =5_sdsI© -' FRor�z7T!!�'ION .TO DR9:4 GELD. 00 NOT N55 F Ai.�u 44 ` I Q No' 2211 •E �:' ..esu 7 eft on ��noFEBsioN 11�-'SOI LS LOG MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION D PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99507 204-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR:6uC W/1�5oO /DATE PERFORMED:_/�l^-��� LEGAL DESCRIPTION: WK, I SLOPE SITE PLAN TI ell 3 6-0 i11AK 4 5 9`�y-�Jo'L'L�f•r(� G:!(il��I'/ �7'I _j'�J' '� 1 �.,7 6 7 8 9 10 11 WAS GROUND WATERS ENCOUNTERED? _ 110 L — O Q �� 12 P IF YES, AT WHAT E 13 DEPTH? Reading Date Gross Time Net Time Depth to Water Net Drop 1 20 L_ PERCOLATION RATE_ —(minutes/inch) COMMENTS PERFORMED BY: 72-008 (6/79) DATE: L WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological 8i Geophysical Surveys Drilling Permit No. LOCATION OF WELL (Please complete either la, Ib or Ic.) A.D.L. No. la. Borough rSubdivision Lot Black Ib. Scu di, is I/4 qt rs. Section No. Township N� Range E� Meridian EiSrAreS G I--of_,of—af_ s❑ WO Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: C - P, )A'1.1SOT-. , iven, Address: 0800 a1 misoi: DY'J vc, Anchorap,e, Ah. Street Address and Area of Well Location L,ot. 6 FiR 1 Sequo:i_a Fst.ates. 2. WELL LOG Feet Below Surface 4. WELL DEPTH: (final) 5. DATE OF COMPLETION V aterlol Type Top Bottom ,. `R t71 ft' ,.. 2' _ 'i_= - /r' 6, O Coble tool QX Rotary Q Driven Ej Dug El Auger ©Jetted C] Bored ❑Other: 7. USE: Q Domestic E] Public Supply ❑ Industry Irrigation Recharge Commerical Test Well 0 Other: ,.Leay-.--��.,✓ ���..:.�..--..,.: ,..,,f. ;) - 3 G/'- �./Cf ';, O , 8. CASING: E] Threaded ® Welded diam._ 4 in. to Ze.-2 p ff. Depth Weight . !' _Ibs./ft. v dlom. /r in. to �'/0 ft. Depth Stickups 1t. 9. FINISH OF WELL: -— — Type: Dlomelsr: Slot/Meeh Size: Length: 01CNC) NpAIT g M�N1UP, pp __c,,Rr Set between _ ft. and ft. � Backfilling Gravel pock r p 10. STATIC WATER LEVEL: }t. .0c)) Date Above or Below land -surface VN can Equipment used:)AfJ,\>`l I . PUMPING LEVEL below land surface and YIELD fl. after hrs. pumping g.p,m, ft. offer hre. pumping g.p.m. - 12. GROUTING Well Grouted: Yee No r ^t Material: 0 Neat Cement 0 Other: _ 13. PUMP: If available) HP -- Length of Drop Pipe ft. capacity g. p.m. O Subm. Jet Centr(flcal Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature —0 C] F O C This well was drilled under my '.pried is tiq� and this report is true to a best of my knowledge and belief; � r ���-;i. �;� J o9isle ed�,Business Name d C � Ctpnlro'CI License Number Signed_ s_o . Date: c - Authorized senitive Form 02-WWR (II/81) Copy Distribution: WHITE - State DGGS, PINK -Driller, CANARY -Customer c N N 0 0 n Z 0 i i f"f'= 20.00 3p F'- /20.00 L- &5.87 � x A yr tr i \� i CmNG, rrao/'o0 000 to . 2 vD�FJl' N d d/_Actr 5� �ti � ri 01 D p N pp <• � / r 60, � Tim/T-Y BECK s �6 `ao �c�o • � X44 3� "'..,.e.-.,.,... :LL 0 CERTIFICATE OF SURVEY I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: Z-07- 1 Lmac`AC 4=%E'121 .10/A E's"7-A irm a AS RECORDED IN THE ANCHORAGE RECORDING PRECINCT, ALASKA, AND THAT THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT, AND THAT THERE ARE NO ROADWAYS, TRANSMISSION LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON. DATED AT ANCHORAGE, ALASKA, THISYQTN DAY OFL!duru"I y 19 _ BARNARD ENGINEERING CONSULTING ENGINEERS • SURVEYORS 203 W. 15TH AVE. ANCHORAGE, ALASKA 99501 PHONE 274-5235 FOR: STrvz k\// &S O" FOC.J/-1'40 .._. /3/1//-7— SURVEY TITLE SCALE: / ""- BOOK NO. py"eOZ DRAWN BY: Cdt--CHECKED BY: gEyfa JOB NO._il%-06- GRID NO. d2-2-41.2 W 4 W L Samad s� I !,p *% �eNO.02294 •: QA , fF0�Fy.• •�•�� dJei ` pq • «� �Pl� r ��_ a`'ESSIONA� _tet Parcel I.D. 017-152-06 I 1 Municipality ofAnchoraram�MAR 16 2016 On -Site Water and Wastewater Prog\ (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: Complete legal description SEQUOIA ESTATES; BLOCK 1, LOT 6 Location (site address) 6800 Gunnison Drive *Anchorage 99516 Current Property owner(s) John Swanson Day phone Mailing address Real Estate Agent Rhonda Price Day phone 830-9791 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: ❑ Individual Well ❑ Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Vadance request for: N/A TYPE OF WASTEWATER DISPOSAL: Individual Holding Tank ❑ Community ❑ Public Sewer ❑ Received by: its COSA to be released to t e engineer, unless otherwise requested by the engineer. COSA Fee $ 5,19(o Date of Payment Receipt Number COSA #ca0 loBS Date: Waiver Fee $ Date of Payment Receipt Number Waiver # N/A 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Garness Engineering Group, Ltd. (GEG) Phone (907) 337-6179 Address 3701 E. Tudor Road, Suite 101, Anchorage AK, 99507-1259 Engineer's Printed Name Jeffrey A. Garness Date 1 b In conducting this evaluation, GEG provided an engineering evaluation of the well and/or septic system in accordance with the guidelines and regulations established by the Municipality of Anchorage and industry practices. The reported results describe the condition of the systems on the date/s of the evaluation. Separation distances were measured to readily identifiable features. Hidden defects or encroachments may exist that were not identified during the evaluation. The operational life of all wells and septic systems depend on a variety of variables including, but not limited to, soil conditions, groundwater levels (that may fluctuate during the year), quality of construction (materials and workmanship), and the water usage of the family utilizing the system/s. These conditions can vary, and are outside the control of GEG. Satisfactory test results do not guarantee future performance of the systems; therefore, GEG makes no warranty (express or implied) regarding the future performance of the well or septic system. GEG makes no representation whether an alternative well or septic system can be installed on the property in the event either of the current systems fail The content of this report is for the sole benefit of the person/party who retained GEG. Reliance upon the information provided in this report by any other person or party, including but not limited to subsequent property purchasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the persorlparty who paid for this report. = QOv\-�YF OgNlol ,p 6. DSD SIGNATURE J ON-SITE System #1 Approved for bedrooms WATER AND m System #2 Approved for bedrooms r�r� WASTEWATER C) PROGRAM �= Disapproved 10%, C,QiJ.` Conditional approval for bedrooms, with the following stipulftf4iERV�G� By: Original Certificate Date: The Municipality of Anchorage Development Services Division (DSD) issues certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist 1( Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet 9-1-12.doe If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: SEQUOIA ESTATES; BLOCK 1, LOT 6 Parcel ID: 017-152-06 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N A Well Log (Y/N) YES Date completed 7/24/85 Sanitary seal (YIN) YES Wires properly protected (Y/N) YES Total depth 240 ft.. Cased to 240 ft. Casing height (above ground) 12"+ in. FROM WELL LOG AT, INSPECTION - Date of test 7/24/85 3/9/1.6 Static water level 200 ft, 206.4 ft. Well production 10 g.p.m. 4.3+ g,p,m, WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.581 mg./L. Collected by: GEG. Ltd. Arsenic: ND ug./L. Date of sample: 2 /24, 16 B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 3 Date installed 7/25/85 Cleanouts (Y/N) YES Foundation cleanout (YM) YES Depression over tank (Y/N) NO High water alar (Y/N) N/A Date of pumping 3 11 ! to Pumper &Dmfi 35 Qyr 1�i �'ecui� C. ABSORPTION FIELDr4ATA BELOW -EXISTING GRADE Date installed 7/25/96 Soil rating (g.p.d./feo /bd 214 System type BED Length 56 & 14.5 ft, Width - 21 & 11 ft. Gravel below pipe 0.5 ft. *2.75+ Totatdepth_ *3.08 ft. Eff. absorption area 1335 fte Monitoring tube YES Depression over field NO Date of adequacy test 13/9/16 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test E in. Water added 039 gal. New depth`3_1 in. Elapsed Time: 195. min. Final fluid depth 0 in. Absorption ratd' _ 600 g,p,d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — INSULATED PER 1985 INSPECTION REPORT D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump off' level High water alarm level at _in. Datum Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankflift station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 104'+ On adjacent lots 100'+ Public sewer main 75'+ Public sewer manhole/cleanout 100'+' Sewer /septic service line 25'+ Holding tank 75'+ Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM-SEPTIC/HOLDING TANK ON LOT TO: Building foundation - 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ ' ' Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *10'+ Building foundation *10'+ Water main 10'+ Water service line 10'+ Surface water 106'# Driveway, parking/vehicle storage 1'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *ASSUMED G. ENGINEER'S CERTIFICATION I cerfify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSH guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date . 3111. bte (Rev. 11/05) Lor s C7 �9B%p0 E / DR J o� G JI'1� Qo Tro M v0' rull I. p 00 \ 3� / • A. 3 0 � lV .Coi G. 5ran . p � .2°� YJ6��YIPO � 41 alIr 90, O" p� K 9 {yiNG1Nu.0. � 1�0 O F1=10.00 � L: Ji4z �ses8� r �� WELG \ -9,96,00 -0o /44.3'/ -- � O M a C/04CLE • Fov"o s/e" Rkra,4, CERTIFICATE OF SURVEY I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: TA TAr-4 AS RECORDED IN THE ANCHORAGE RECORDING PRECINCT, ALASKA, AND THAT THE IMPROVEMENTS SITUATED THEREON ARE LOCATED AS SHOWN ON THIS PLAT, AND THAT THERE ARE NO ROADWAYS, TRANSMISSION LINES OR OTHER VISIBLE EASEMENTS ON SAID PROPERTY EXCEPT AS INDICATED HEREON. DATED AT ANCHORAGE, ALASKA, THIB167� DAY OP� nr��4"r-r I3A4 BARNARD ENGINEERING CONSULTING ENGINEERS • SURVEYORS E03 W.ISTH AVE. ANCHORAGE, ALASKA 39601 PHONE 274'6230 A Ri //LT SURVEY TITLE SCALE, 19 130 BOOK NO. DRAWN BY, _CHECKED BY, E 'ES3 JOB NO. AL -a/ GRID NO.. 29;9 r�'1 Eal R 3 .d .4y. ND. If I1J l,,.t4L � NO.3YP{ FOR: STEVE kvo. so" I�, 9y'.. _f_�°S :a- a"•••,..•••:'s Parcel I.D. 017-152-06 7E Municipality of Anchorage On -Site Water and Wastewater Program (907)343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Complete legal description Expiration Date: 13—/7—/3 SEQUOIA ESTATES BLK 1 LT 6 Location (site address) 6800 GUNNISON DR, ANHCORAGE AK 99516 Current Property owner(s) MARIT &JIM CROAK Mailing address Real Estate Agent BARB MICHELLSON 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 4 Day phone Day phone 230-5577 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Fl Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: NONE Distance: --- Received by:Date: 6 l � COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 00, t o Waiver Fee $ Date of Payment &111&,3 Date of Payment Receipt Number �J/n1Do2`� Receipt Number COSA# Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm SPURKLAND ENGINEERING Phone 279-3916 Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND Date 6/6/13 OF..A4 11 6. DSD SIGNATURE T H IFP System #1 Approved for bedrooms • • • . t�v'VU&' .. 0 r J URKIAND. System #2 Approved for bedroomseco Disapproved 1�11FOpnM1 ���'^=a L JO 'aw Conditional approval for bedrooms, with the following stipulea��i�I , ®""'_ - By: Original Certificate Date: 6-17-13 Th uni " aljt o c orage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the rep sentations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSAN.esheet r - If more than 1 septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: SEQUOIA ESTATES BLK 1 LT 6 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID #- Date completed 7/24/85 Sanitary seal (Y/N) Y Total depth 240 ft. Cased to 240 ft. FROM WELL LOG Date of test 7/34/85 Static water level 200 Well production 10 WATER SAMPLE RESULTS ft. 9 - p.m - Coliform NEG Monies/100 mL Nitrate 0.888 mg/L Arsenic ND ug/L Date of sample: 5/22/13 B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Parcel ID: 017-152-06 Well Log (Y/N) Y Wires properly protected (Y/N) Y Casing height (above ground) >12 in. AT INSPECTION 5/29/13 206 ft. g.p.m. Collected by: ANSON MOXNESS Date installed 7/25185 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Date of pumping 5/30/13 Depression over tank (Y/N) N Pumper ISAAC'S PUMPING High water alarm (Y/N) N/A C. ABSORPTION FIELD DATA Date installed 7/25/85 Soil rating (g.p.d./ff or fe/bdrm) 214 System type BED Length 56 ft. Width 21 ft. Gravel below pipe 0.5 ft. Total depth 3 ft. Eff. absorption area 1335 fe Monitoring tube Y Depression over field N Date of adequacy test 5/29/13 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 310 in. Water added 600 gal. New depth 5/3 in. Elapsed Time: 30 min. Final fluid depth 3/1.5 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed "Pump on" level at Datum Size in gallons in. "Pump off' level at in. Cycles tested E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >100, Absorption field on lot >100' Public sewer main NA Manhole/Access(Y/N) High water alarm level at Meets alarm & circuit requirements? On adjacent lots >100, On adjacent lots >100' Public sewer manhole/cleanout NA Sewer /septic service line >25,Holding tank NA Animal containment areas >50 Manure/animal excrete storage areas >100, SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >5 Water main NA Water service line >10, Wells on adjacent lots >100, ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10' Water Service line >10' Surface water >100' (N.O.) Curtain drain >50' (N.O.) Wells on adjacent lots >100, F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LARS SPURKAND Date 5/30/13 COSA brown sheet 10-10-12.doc Absorption field >5 Surface water >100' (N.O.) Water main NA Driveway, parkingivehicle storage >10' 0' 49 a, OFA` III in. r Municipality of Anchorage -.. Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.enchorage.ak.us (907)343-7904 Parcel I.D. CERTIFICATE OF HEALTH AUTHORITY APPROVAL 017-152-06 FOR A SINGLE FAMILY DWELLING' ,Vz.:HAA# Nig Ol0a38 Expiration Date: 1S,- GENERAL INFORMATION Lot 6, Block 1, Sequoia Estates Complete legal description Location (site address or directions) 6800 Gunnison Drive Current Property owners) Don McCray Mailing address Lending agency Mailing address Day phone 345-1039 6800 Gunnison Drive, Anchorape, AK.99516 Day phone Real Estate Agent Gallery Homes/Debbie_Mnorp Dayphone 967.-16'Aa Mailing Address 2120 Denali sui P R, Anrhnrnpp AX 99Sn1 Unless otherwise requested, NAA will be held by DSD for pickup. �✓� �- G/v►— r� s�o t 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site ID Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results less than 30 days old. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below. I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Address 17014 Eagle River Loop Road No. 204 Ala Engineer's Printed Name Rotiert C. Cowan, P.E. 5. DSD SIGNATURE Approved for + bedrooms. Disapproved. Phone 6q `f —7L9 "7 Cl Date S/rg/°/ z< -CC OF A, RWNT C. COWAN I e - CE -8801 r 4 Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist ' X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By:. (� / Original Certificate Date: (Rev. MCC) Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water S Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage. AK 99519.6650 www.d.enchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L e; 6 17LB GK I S Gdupl/F EST*' E S Parcel-fra -O 6 A. WELL DATA Well type p,%I*r c Date completed7�i'r /tr if A, B, or C provide PWSID # Sanitary seal &N) —W5- Total depth a N 0 ft. Cased to 01 yJ ft. FROM WELL LOG Date of test 74.1 / SS - Static water level Well production WATER SAMPLE RESULTS: /0 9 - p.m - Coliform colonies/10o ml. Date of sample: S-/17/01 B. SEPTIC/HOLPING TANK DATA Nitrate 02" mg.A. Well Log JDN) yES Wires property protected &l) YE f Casing height (above ground) � A In. AT INSPECTION S'/r7 /O / a o y ft. ±i. q + g.p.m 4Y P✓nPJZ- Other bacteria D colonies/100 ml. Collected by. S a S ENGINEERING Eagle01 River Loop Road No. 404 Eayaa River, Alaska 99577 Tank Type/Material S2P ' 1 e - l S T E d L Tank size / A5,6 gal. Number of Compartments Z Foundation cleanout &N) J_L[ Depression over tank (YAM td Date of pumping r Xao i Pumper Date installed 7 /.% r/ g S Cteanouts &N) Y 6's High water alar (Y/N) Al 1A QoTo Asor6/t C. ABSORPTION FIELD DATA Date installed l -A J/ SS' Soil rating (g.p.d.1W or /bd a! y System type IIco Length sL t ft. Width X1 t ft. Gravel below pipe 0.r ft. Total depth 3 ft. Eft. absorption area 131r P2 Monitoring tube yEr Depression over field 110 Date of adequacy test S/1.1 /0 r Results Pas ail) PAJ! For! bedrooms Fluid depth in absorption field before test 0 In. Water added gal. New depth24L in. Elapsed Time: ) 3 min. Final fluid depth7�4 in. Absorption rate >= 166 Q g.p.d. P*4.# Any rejuvenation treatment (past 12 mo.) (YIN 8 type) K "'ow n/ If yes, give date 0. LIFT STATION Date installed Size in gallons _ "Pump on" level at _ In. "Pump air level at Datum y as tested_ E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: I Septic tankAtft station on lot J d O t Absorption field on lot water alarm level at Meets alarm 6 Bradt requirements? On adjacent lots 100 O0 , On adjacent lots 100 �; Public sewer main N A Public sewer manholeldeanout _ Sewer /septic service line -;L r r"1 Holding tank AI 14 SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO: I _ r /� / Building foundation S f Property line S "r Absorption field S Water main lu ( _A Water serAx line 10 I ; Surface water ! 00 > A/14 Wells on adjacent lots J O 0 + SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: r � Property line % O Building foundation ° f Water main N A r Water Service line 10 F Surface water /00 r Driveway, parking/vehicle storage S 4 Curtain drain N0Wrl. Ka oWN Wellson adjacent lots 0 14. F. COMMENTS G. ENGINEER'S CERTIFICATION I car* that I have determined through field inspections and '2h review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. " Engineer's Printed Name h6"r C . Cow.4rj �j+ ,�y,kk w1h, I � Date r�r 410, + `i,;:�, HAA Fee $ 3 0 4. Date of Payment S' /a r /Q( Receipt Number O o V 63 ri (Rev. 12100) Waiver Fee $ Data of Payment Receipt Number in. MAY -23-01 10:02 FROM - L CUE Environmental Services Inc. Cr&E Rer.M 1012726001 Client Name S & S Engineering Project NameN Lot 6 Block 1 Sequoia Estates Client Sample ID Lot 6 Block 1 Sequoia Estates Matrix; Drinking Water Ordered By PWSID 0 Sample Remarks: T-956 P.02/03 F-359 Client PON Printed Datc/Ttme 05/22/2001 11:30 Collected Date/Time 05/17/2001 13:45 Received Date rime 05/17/2001 14:38 Technical Director Stephen q Ede , Released W7 9 Gs¢1 Allowable Peep Analysis Parameter Results PQL Units Mefta t imiu Date Date Ia Waters Department Nitrate -N 0.922 0.500 mg/L EPA 300.0 Microbiology Laboratory Total Coliform 0 0 col/100m], SM189222B Y' r (<10) 05/17/01 SCL 05/17/01 SKW - MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D. #� 1Z� r�-� �� HAA # 0 A') � 0 1 n 2L 1. GENERAL INFORMATION Complete legal description t``'-' �'' ',r�•t tf� Location (site address or directions) 1 + _ Property owner -< `: (L,t..' 3% �t/,> I �ti.•,f- Day phone Mailing address . Lending agency Day phone Mailing address Agent , 7�.s% (; ; �� Day phone i(o l' r i Address .i'.r,1 �_�', . i',;C;'(i i Y /• Unless, otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well 1 Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: / Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and -as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm ' L ✓�e CK La. ` Phone Address S4,4 .6 Engineer's signature 6. DHHS SIGNATURE X Approved for Z bedrooms. Disapproved. Conditional approval for Additional Comments M aUTlr Date (0` 7 3 {,'( 1 ��)y��, .0. cf65,/a ,� ruuti �a y� bedrooms, with the following stipulations: Date � - 24 - 93 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA W21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: fir. -. l3, %_� l ��r't'! Parcel I.D. A. Well Data Well type - If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) T/ Date completed Driller 1, �� , l Total depth l •_ Cased to Casing height Sanitary seal (Y/N) V Wires properly protected (Y/N) FROM WELL LOG AT INSPECTION Date of test y '[ — S' %' �� MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Static water level Well flow ! g.p.m.iv 1 4 1�9� J g.p•. Pump level! I � '1-� n -�) !` '' %1' r RECEIVED SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot ' / -/u ; On adjacent lots . / -/ L Absorption field on lot 'I l .'�t_i ; On adjacent lots i �> Public sewer main ~��� Public sewer manhole/cleanout Sewer service line / -- Petroleum tank H 10 WATER SAMPLE RESULTS: Coliform Nitrate �)- e. r Other bacteria C II Date of sample: % ? Collected by: S- - B. SEPTIC/HOLDING TANK DATA Date installed r -, '%:� Tank size Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) P_-1 High water alarm (Y/N) C 141\ Alarm tested (Y/N) Date of pumping &Z :'> Pumper f SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot J / V (-D On adjacent lots Foundation 7 To property line : . 1 Absorption field s Water main/service line d Surface water/drainage f-' � 72-026(3!93)' Front CONTINUED ON BACK PAGE C. LIFT STATION / r Date installed Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: MTV!1[.77ran D. ABSORPTION FIELD DATA On adjacent lots Manufacturer Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed -; i -'' Soil rating (GPD/Ft2) / LZ System type j c� (j Length 7L Width It t' %'-j Gravel thickness Total depth t Total absorption area ! / ` _J Cleanout present (Y/N) Date of adequacy test"! ,r : Results (pass/fail) Water level in absorption field before test Depression over field (Y/N) for Bedrooms test Peroxide treatment (past 12 months) (Y/N) fel If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: ,/ Well on lot > / c, On adjacent lots f /3 _, Property line `i i C To building foundation To existing or abandoned system on lot N On adjacent lots ? :5e� Cutbank t") a i,i t'_ Water main/service line 3 of__° Surface water C i v vt 4 Driveway, parking/vehicle storage area Curtain drain I_, E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. /f t Signature. ,G! amu-✓/ Engineer's Name i Date+.%�c,c HAA Fee $ 4 _/Q 4Sy Date of Payment 6' - Receipt Number 72-026 (3/93)` Back Waiver Fee $ Date of Payment Receipt Number COMMERCIAL TESTING & ENGINEERING CO. AIL ENVIRONMENTAL LABORATORY SERVICES SINCE 1908 IINVORT o" AHMA' 1.c� r Fit *1 ;�J ) 1 Z ( ' 'L � 1 4, 1) 5 3 - ANCHORAGE, 5633 B STREET AK 99518 C. c1l It pit" Nfjy)] 1,, 11) 6/1i1001A ES 13E.0T I TEL: (907) 562-2343 il ri -.'( 1-1 A"I I I'. I ", FAX: (907) 561-5301 (J'tfmN, Allif, �TOBBI-N 5PURRUVID, PJ" 1-70PIC 0f' -d(!.1- :6()B()6 OT"l1('):EN), 1311 "I P.eport Cowplek.ed 06/09/9`3 N-o-Joet Now", ('o.Ij 06/05/9:; OVOCIP"I 0 1, 1, (1 h!" i '10I -UA 'Pe( h';) icll W XI !;oult'le 'ROUTTNE '-AMPF-W' CON.J.'CIT111) 137: STIJAIVI Al r Posolits Qwll UI I 1.-. 11 1O'l 1 A III D' I 1.11.1,1'. 0 , Il j, -------- --- mg/r. 1111A, 351 ')/3()() , i3O OE/0J 1 J Suo, Bpcjr-O, Ahove, UA 111 li, 1.:� Sayfolt, RIC'1nark"), Move N'x)L 0 Tjnck�;�ncl:cd' Retx-)rted Volue" 1115 -i -he 11T Thim n ,-,,11-lonoary tul'tui.-A-cm, G1, = Gr(j 12'0%sais Member of the SGS Group (Societe G&n6rale do Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 1 264-4720 Application Date 6 M -97 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L07'� BcO& / Location (address or direc ions) V p� ,ti A�• S�uo��4 e/�. (b) Applicant Name �`a!��*� (�/L3ox% Telephone: Home 3T - NV Business Applicant Address %1 E %72 /44' JlWell. 'e 9 75rd- / (c) Applicant is (check one): Lending Institution; Owner/buildt*Buyer ❑ ; Other ❑ (explain); - (d) Lending Institution C Telephone Address . - _e= - (e) Real Estate Company and Agent Address Telephone (f) 2. TYPE OF RESIDENCE Single -Family Multi-Fam'l ❑ Other Number of Bedrooms - 3. WATER SUPPLY Individual Well,` Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community CI Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025(11/84) �lv /3/ il�Tluoiri �5'T 5. ENGINEERING FIRM PROVIDINC 3PECTIONS, TESTS, FILE SEARCH, DAT ND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address �a Date C XAi7iW.9l� 4F/10�Q - S /?V, a✓cr2 s-eTic 77P4 4( I*VA16 4VIZLc c�4siAk� *-f ate/ Ra.66. GJ�L Gal&S /A% CjWNt I7T. Ll Telephone 0 A4 N•�v. ••er •••.••�,d:• •�(, RO C. REID, !R. : �r L4� a is 98a12251 • �� DHEP APPROVAL Approved for ��" bedrooms by ��'�'`` �" / '" ' Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) SP/'go/ct 4' S1Wf5 F / Location (address or directions) r 61v044 off Secttvra (b) Applicant Name �!�&" Telephone: Home 3 ! r Business Applicant Address Z21 E 7f4 �>TZ / "`��°U QSte'/ (c) ,'Appl(cant is (check one):' Lending Institution ❑ ; Owner/builder q-, Buyer ❑ ; Other ❑ (explain); (d) Lending -.Ins i.tution Telephone Address (e) Real Estate Compariy,aho Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family P_ Multi -Family ❑ Other — Number of Bedrooms 3. WATER SUPPLY Individual Well K 'Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Pa 1 of 2 72-025 (11/84) a 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm �G'G ` G Telephone Address -4 15 u c car/fio e' r l� Date 7 - 746 �//�� / uGt 7 I ( p w ,/ ( �/ /r / IiL�Gdcvr.h P�+�( �0 i iv.t�c �/�C,v/�� 1`rn�(/fG7'� O't'Ssra�s OUcn!' ra'e��']`iC ''u�c�/ ��c( �v��� Cosi G etcu'rec-41Y d'lG( �y1Otcwoif .„�.�-ate a AN 01glin •.I •.� "� Qn A e�u•ofNy,fo,••I�••.••,• r �J 6. DHEP APPROVAL Approved for "{ iroC. Reid, Jr. Vo. 2251-E ( '4j... got y+V�� N� Essoo\ N24 bedrooms by '�°"'"" Date _ Disapp)r§ved Conditional — Terms of Conditional Approval w ra 50rv,. 5 we -I( / • 714p w CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) QKI ITI"4 Bo UARY 1984 d JAgal Description:�2Gr4ia �s ( t/ N011�31021d "IV1N3 .N0211AN3 N A. WELL DATA 'S H11V31-1 do 'ld30 9JVa0HJNV d0 UIIVdl:)INf1W Well Classification s� Pr fQAfe- If A, B, C, D.E.C. Approved (Y/N) — � Well Log Presen0N) _ Date Completed 7"jN-` D Yield ld Pon Total Depth ;=qL Cased to — Q— Depth of Grouting __(4(AL14eW1^ Static Water LevelPump Set At Casing Height Above Ground Sanitary Seal on Casing) Electrical Wiring in Conduit (Y16____0_ Y/� 0 Depression Around Wellheado/N) Separation Distances from Well: rY To Septic/Holding Tank on Lot 5 On Adjoining Lots X00 To Nearest Edge of Absorption Field' Ion Lot /S S r ; On Adjoining Lots — oo r' To Nearest Public Sewer Line NA To Nearest Public Sewer Cleanout/Man holer{%(\ 11�� 4 To Nearest Sewer Service Line on Lot 75-4 Water Sample Collected by Date —c2q Water Sample Test Results _ ?�TiS qac ov Comments—ate, ��4©W B. SEPTIC/HOLDING TANK DATA Date Installed Size IJ, '5_0 No. of Compartments C?- Standpipes 2Standpipes @ N) Air -tight Caps ON) Foundation Cleanout/(y� Depression over Tank�(Y ) 0 d Date Last Pumped M �� Pumping/Maintenance(( Contract on File (Y/N) moo) _ ; for k1l Holding Tank High -Water Alarm (Y/N) _ Temporary Holding Tank Permit (Y/N) g Separation Distances from Septic/Holding Tank: r � To Water -Su I Well i� To Buildin Foundation S To Property Line 42 To Disposal Field To Water Main/Service Line 50 Y j To Stream, Pond, Lake, Comments r% A iClr �zvt L .x a d '5e t/'o yt,ex a�orµy :, Page 1 of 2 72-02N11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata a14( Type of System Design �ecb Date Installed 7 — a5- Length of Field Width of Field Depth of Field �' a `i Gravel Bed Thickness Square Feet of Absorption Area Standpipes Present( N) Depression over Field (YO Date of Last Adequacy Test /114 Results of Last Adequacy Test l� Separation Distance from Absorption Field: To Water -Supply Well ISS To Property Line /0 r To Building Foundation i0 To Existing or Abandoned System on Lot PA ; On Adjoining Lots 67- _5e r �I To Water Main/Service Line 50 f To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course 1--/00 To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Man Dimensi G,-ccess (Y/N) p Off' Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check PePmitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed a� &-e-- Date �`(-FG Company EG c MOA No. ��✓ Receipt No. �3 Date of Payment --i `�L' 4!ili OF At o Amount: $ c)c) d �_G. gi 6464VA Page 2 of 2re C. Reid, Jr.t*+� No. 2251.6 •Gw k�F�SS�;Jt,,